Author Affiliations: Division of Ophthalmology (Dr Fletcher), Departments of Clinical Neurosciences (Drs Fletcher and Almekhlafi) and Pathology (Dr Auer), and Hotchkiss Brain Institute (Drs Fletcher and Auer), University of Calgary, Calgary, Alberta, Canada.
A 69-year-old man was referred with a 3-month history of diplopia and left ptosis. During the previous 7 years, he had progressive loss of left trigeminal and facial nerve function, initially affecting the upper trigeminal branches and culminating in complete hemifacial anesthesia and paralysis. No cause had been found despite repeated neurological assessments and 3 magnetic resonance imaging scans. Neuro-ophthalmological examination showed a new left oculomotor nerve palsy. He denied prior health issues but specific questioning about skin cancer prompted review of pathological records, which revealed that a basal cell carcinoma had been excised from his forehead 4 years before the onset of neurological symptoms.
Fletcher WA, Almekhlafi M, Auer RN. Multiple Cranial Neuropathies Evolving Over a Decade From Occult Perineural Basal Cell Carcinoma. Arch Neurol. 2012;69(1):134-135. doi:10.1001/archneurol.2011.1064